Type III odontoid fractures are rarely associated with neurologic injury6, this is why our patient waited two days before coming to the hospital, and they can be easily missed on initial evaluation6 as happened with the negative frontal X-rays of the mandible (skull and C-spine) in our case. That is why in an old individual with fragile bones (osteoporosis) and decreased range of motion (spondylosis) mild trauma may cause C-spine fracture with mild neurological injury.Ĭommon symptoms of odontoid fracture are high posterior cervical pain, sometimes radiating in the distribution of the greater occipital nerve (occipital neuralgia) with paraspinal muscle spasm, reduced range of motion of the neck and tenderness to palpation over the upper C-spine. Old people usually have decreased cervical mobility and reduced ranges of motion8. The range of lateral bending is about 30-50°. Bilateral rotation is about 80° with approximately 50% of this range occurring between C1 and C2. In a young person, cervical flexion and extension is about 100°. The many articulations between the cervical vertebrae make possible the extensive range of motion in the cervical spine. In patients over 70 years of age, simple falls may cause the fracture 6, as happened with our patient. Significant force is required to produce an odontoid fracture in a young individual, which usually happens due to MVA, fall from a height, skiing accident, football injury, wrestling … etc. This type of fracture is often considered a variant of traumatic spondylolisthesis of C2. Type III (30 %): Basilar fracture, with a fracture line passing into the body of the axis.Īnother type of odontoid process fracture is a vertical fracture through the odontoid process and body of the axis (less than 5% of cases). These fractures are very prone to non-union unless sufficient stabilization of the fracture site can be provided. It corresponds to the odontoid neck fracture in the De Morgues and Fischer scheme. Type II (60 %): Body fracture, which passes above a horizontal line drawn through the upper border of the superior articular facets of the axis. The system most widely used in the English-speaking countries is that of Anderson and D'Alonzo (1974) 5: The earliest classification was that of De Morgues and Fischer (1972), which distinguished between fractures of the base and fractures of the neck of the odontoid process. Throughout the literature, attention has always been drawn to the fact that many of these fractures are detected late after the traumatic event, and that odontoid fractures are notoriously prone to non-union. Odontoid fractures were first described, by Lambotte, more than a century ago (1894). The atlantoaxial (C1/C2) articulation is made up of 3 joints - the central atlantoaxial joint and the paired lateral atlantoaxial joints. The unique features of C2 anatomy and its articulations make assessment of its injury challenging. Clinical manifestations range from minimal upper extremity motor and sensory deficits to quadriplegia with respiratory center involvement. Craniocervical junction injuries are the deadliest. Correlation is noted between the level of injury and morbidity/mortality (ie, the higher the level of the C-spine injury the higher the morbidity and mortality). C-spine injuries are the most feared of all spinal injuries because of the potential for significant deleterious sequelae. MVAs and falls are responsible for the majority of the Axis (C2) fractures. As many as 10% of unconscious patients who present to the emergency department following motor vehicle accidents (MVAs) have C-spine injury 4. More than 60% of spinal injuries affect the C-spine, and approximately one out of five cases of all C-spine injuries involve the axis 2, 3. The incidence of acute cervical spine (C-spine) injury due to blunt trauma in adult patients admitted to emergency centers ranges from 1.9 to 3.8 % 1.
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